Alonso Flores

Influence of highly active anti‐retroviral therapy on response to treatment and survival in patients with acquired immunodeficiency syndrome‐related non‐Hodgkin's lymphoma treated with cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone

Combined highly active anti‐retroviral therapy (HAART) with protease and reverse transcriptase inhibitors has modified the natural history of opportunistic infections and neoplasms in human immunodeficiency virus (HIV)‐infected patients. We analysed the influence of HAART on the response to treatment and survival in a series of 58 patients with acquired immune deficiency syndrome (AIDS)‐related non‐Hodgkins lymphoma (NHL) treated with CHOP (cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone). Two groups of patients were included: (i) forty‐one patients diagnosed with NHL between 1988 and 1996 who were not treated with HAART; (ii) seventeen patients diagnosed since 1996, who were receiving or commenced HAART when NHL was diagnosed. The response rate to CHOP was higher in group 2 (13 out of 17 cases; 75%) than in group 1 (14 out of 41 cases; 34%) (P = 0·003). The 2‐year probability of event‐free survival (EFS) [95% confidence interval (CI)] for group 1 was 0·5 (0·24–0·74), whereas for group 2 it was 0·85 (0·61–0·90) (P = 0·024). The lymphoma‐free survival (LFS) was also significantly different for both groups (2‐year LFS probability 0·53 vs. 1·0, P = 0·04). The median (95% CI) overall survival (OS) for group 1 was 7 months (range, 3–10·8 months), whereas it was not reached in group 2 (P = 0·0015). In the multivariate analysis for remission attainment, the only variables with a higher probability to achieve complete remission (CR) were HAART (P = 0·01) and International Prognostic Index score 1 (P = 0·02). The only statistically significant variable in the multivariate analysis for EFS was HAART (P = 0·049) and the variables with prognostic value for OS in the multivariate analysis were B symptoms (P = 0·01) and HAART (P = 0·003). Patients with AIDS‐related NHL treated with CHOP and HAART had a higher CR rate than those treated only with CHOP. In this study, HAART was an independent prognostic factor for CR, OS and EFS in patients with AIDS‐related NHL.

Acute Promyelocytic Leukemia in a HIV Seropositive Patient

Acute myeloid leukemia (AML) is infrequent in patients with human immunodeficiency virus (HIV) infection. Among AML, acute promyelocytic leukemia (APL) has been rarely described in such patients, with only one case being published. We report a 30 years-old intravenous drug abuser HIV-infected male with APL who attained complete clinical, morphological, and molecular remission after differentiation therapy with all-trans-retinoic acid (ATRA) followed by intensive chemotherapy. The results of treatment in this patient and in other AML published cases suggest that therapy for AML should not be modified because of HIV infection if patients have an adequate performance status.

Usefulness of tumor markers CA 125 and CA 15.3 at diagnosis and during follow-up in non-Hodgkin's lymphoma : study of 200 patients

CA 125 and CA 15.3 serum levels were measured at diagnosis, after treatment and at the time of recurrence in 200 consecutive patients (114 males, median age 56 years) with non-Hodgkins lymphoma (NHL) to explore its usefulness in the evaluation of response to treatment and survival in patients with NHL compared to lactate dehydrogense (LDH) and β2-microglobulin (β2-M). Their association with the clinical – biologic parameters at diagnosis, response to treatment, event-free survival (EFS) and overall survival (OS) was analysed. Eighty-six patients (43%) had elevated CA 125 levels and 35 (17.5%) had elevated CA 15.3 levels at diagnosis. CA 125 was associated with advanced stage, lung, pleural or gastrointestinal tract involvement and CA 15.3 was correlated with advanced stage, bone involvement, aggressive histology and bulky disease. LDH had the highest predictive value for failure to achieve complete remission (P = 0.001). A shorter OS was associated with increased LDH (P < 0.0001), β2-M (P = 0.013) and CA 125 (P = 0.025) whereas CA 15.3 was associated with a shorter EFS (P = 0.027). When elevated at diagnosis, CA 125 and CA 15.3 should be monitored during follow-up of patients with NHL.

Electron Microscopic Identification of Parvovirus Virions in Erythroid and Granulocytic-Line Cells in a Patient with Human Parvovirus B19 Induced Pancytopenia

In this short report we describe a patient with human parvovirus B19 (HPV B19)-induced transient pancytopenia. Parvovirus virions were seen by electron microscopy in both erythroid and granulocytic precursors. Erythroid cells are not the only targets in these cases. We draw attention to this disorder so that physicians involved with hematological disorders and transplantation be more aware of this infection.

Neumonías en pacientes con leucemia linfática crónica. Estudio de 30 episodios

Fundamento Analizar la etiologia, los metodos diagnosticos y la respuesta al tratamiento en 30 episodios de neumonia diagnosticados en 17 pacientes con leucemia linfatica cronica (LLC) entre 1995 y 2000. Pacientes y metodo En cada episodio se registraron los siguientes parametros: edad, sexo, tratamiento de la LLC, profilaxis antiinfecciosa, granulocitopenia, cociente de linfocitos CD4 y CD8, hipogammaglobulinemia, tipo de neumonia (intra o extrahospitalaria), localizacion, insuficiencia respiratoria, necesidad de ventilacion mecanica, tratamiento antimicrobiano y respuesta. Se realizaron hemocultivos, cultivo de esputo, fibrobroncoscopia y deteccion de antigenos en orina (Legionella pneumophila serogrupo 1, galactomanano y Streptococcus pneumoniae). Resultados La edad mediana de la serie fue de 60 anos (limites, 50-86); 12 eran varones. La combinacion de clorambucilo y prednisona fue el tratamiento mas utilizado para la LLC (13 pacientes) seguido de la fludarabina (8 casos). Existia granulocitopenia en 14 episodios, habia hipogammaglobulinemiaen 22 y el cociente de linfocitos CD4 y CD8 fue inferior a uno en 8 de 14 determinaciones. Se establecio la etiologia de las neumonias en 16 episodios (53%). La fibrobroncoscopia fue la prueba con mayorrentabilidad diagnostica (83%), seguida de los hemocultivos (38%). Dos pacientes fueron diagnosticadosen la autopsia de aspergilosis pulmonar. El neumococo fue el germen aislado con mayor frecuencia(5) seguido de Pseudomonas aeruginosa (4), Pneumocystis carinii (2) y Aspergillus fumigatus (2). Delos 2 pacientes con neumocistosis uno habia recibido fludarabina y el otro glucocorticoides de formaprolongada. Diez pacientes (30%) fallecieron a causa de los siguientes germenes: P. aeruginosa (3),P. carinii (2), A. fumigatus (2), Mycobacterium xenopi (1) y germen no identificado (2). Conclusiones En esta serie de pacientes con LLC la tasa global de diagnostico etiologico de las neumonias fue aceptable. El germen mas frecuente fue el neumococo. Las neumonias por microorganismos oportunistas se relacionaron con la administracion de fludarabina o el tratamiento prolongado con glucocorticoides y tuvieron una elevada mortalidad.